PRESENTED BY:

Priyanka Kumari
 SPECIFIC OBJECTIVES
• Describe about communication
• To explain about forms of
communication
• To explain about therapeutic
communication
• To understand about technique of
therapeutic communication
• To know about the factors for the success
of therapeutic communication
• Describe about characteristic of therapeutic
communication
• Describe about therapeutic nurse patient
relationship
• To explain about barriers about therapeutic
communication
• To explain about phases of nurse patient
relationship
• To explain about nurses role in therapeutic
communication
 INTRODUCTION
Communication refers to the reciprocal exchange
of information, ideas, beliefs, felling, and attitude
between persons or among a group of persons. It
is a goal directed process in which people use a
system of symbols and sings to convey a message
.
 we communicate when we talk and also when
we don’t talk. We communicate when we move
when we are still. we communicate within
ourselves and with others. Communicate in is
very significant in nursing. Nursing process
itself is a communication process
 DEFINITION OF COMMUNICATION

 Webster’s new collegiate dictionary defines

communication as a process by which
information is exchanged between individuals
through a common system of symbols ,signs or
behaviour
or
 According to Paul Leagens ‘a process by which
two or more people exchange ideas, facts,
feelings ‘common understanding’ of meaning,
intent and use of a message ‘
 Intrapersonal communication is a powerful form
of communication that occurs within an
individual. this level of communication is also
called self talk ,self verbalisation and inner
thought people’s thoughts strongly influence
perception, feelings, behaviour, and self-concept
and you need to aware of the nature and content
of your own
 Thinking .Nurses and clients use intrapersonal
communication to develop self awareness and a
positive self concept that will enhance
appropriate self expression
 Interpersonal Communication
Interpersonal communication is one –
to-one interaction between the nurse and another
person that often occurs face to face .it is the level
most frequently used in nursing situations and
lies at the heart of nursing practice .nurses work
with people who have different opinions,
experiences, values, and belief system, so it is
impotent to validate meaning or mutually
negotiate it between participants.
Transpersonal communication
It is interaction that
occurs within a person’s spiritual domain. Many
persons use prayer, meditation, guided reflection,
religious rituals or other means to communicate
with their higher power .nurses have
responsibilities to assess client’s spiritual needs
and intervene to meet those needs
 Small group communication

It is interaction that occurs when a small

number of persons meet together .this type of
communication is usually goal directed and
requires an understanding of group dynamics .
 Public communication
It is interaction with an audience
.nurses have opportunities to speak with group
of consumers about health related topics ,present
scholarly work to colleagues at conferences, or
lead class room discussion with peers or students.
Referent
The referent motivates one person to
communicate with another. In health care setting ,
sight, sounds, odours, time schedules, messages,
object, emoting sensation, perception , ideas, and
other cues initiate communication .
Sender and receiver
The sender is the person who encodes
and delivers the message, and the receiver is the
person who receives and decodes the message
Messages
The message is the content of the
communication .it contains verbal .nonverbal and
symbolic language
Channels
Channels are means of conveying and
receiving messages through visual, auditory, and
tactile senses
Feedback
Feedback is the message the receiver
returns. It indicates whether the receiver
understood the meaning of the sender’s message.
Interpersonal variables
Interpersonal variables are factors
within both the sender and receiver that influence the
communication .interpersonal variables include
perception, privacy, educational and developmental
levels, socio-cultural back ground , values and beliefs ,
emotions, gender, physical health status and role and
relationship . Variables associated with illness, pain,
anxiety, and medication effects, also affects nurse client
communication

Environment
The environment is setting for sender receiver
interaction. For effective communication the
environment need to meet participant needs for
physical and emotional comfort and safety
THERAPEUTIC COMMUNICATION
The therapeutic interaction between
the nurse and the client will be helpful to develop
mutual understanding between two individuals.
Interaction is a learning experience for both client
and for the nurse and a corrective emotional
experience to the client to modify his behaviour.
 DEFINITIONS
The nurse directs the communication towards the
patient to identify his current health problems, plan,
implements and evaluates the action taken

Bimala kapoor, 2002

Promotes mutual understanding, establishes a
constructive relationship between the nurse and the
client

Kozier, 2004
It is a process ,in which the utilizes a planned
approach to learn about the client

Potter A, 1997
 To achieve self realization ,self acceptance , self
respect ,personal identity, personal integration
 To formulate good interpersonal therapeutic
relationship
 Satisfy needs and to achieve realistic personal
goals
 Permits the client to express their thoughts
truly, openly.
 Improves client’s ego strengths
 Encourages socialization and family interaction
process
 Treats communication problems
 Modifies maladaptive behaviour into adaptive
behaviour into adaptive behaviour
 Motivates the client to utilize the new coping
strategies
 Helps the nurse to identify and intervene
appropriate nursing approaches
 Implement nursing process effectively
Verbal communication
Factual information can be conveyed through
language or words .it is an accurate and effective
medium of communication
 Message or information conveyed through the
behaviour or body languages or by utilization of five
senses. it communicates interest ,respect, genuineness;
checks through feedback
 Vocal cues /paralinguistic cues , e.g. noise , tones,
sounds, and extras sounds
 Action cues /body movements ,e.g. posture,
expression , gestures, mannerisms, and other action
 Object cues ,e.g. dressing , furnishings, possessions
 Space, e.g. nature and relationship between two
cues or people

 Touch-to provide comfort
 Attitudes
 Appearance
 Nodding of head
 Eye to eye contact
OBSERVING
Observing is made by the nurse of wringing of
hands, wiping perspiration, dry lips , speaking in a
very low tone. The nurse is making observation of a
nonverbal communication

LISTENING
As the patient is talking, the nurse responds by
nodding her head, of by saying. Yes I follow what
you told me. The nurse is actively listening.
RESTATING
The nurse restates or repeats what the patient
has been saying .it can be in the form of a question
or a statement

For example----
 Patient:- My children are going through a
financial problem because am sick
 Nurse:-your children are going through a
financial problem because you are sick
 The nurse is restating the statement to increase
the patient’s awareness of his children’s suffering
due to his sickness
VALIDATING
It is a technique which the nurse uses to
confirm the accuracy of data or information given by
the patient
For example----
 Patient; I get very upset when my husband beats
me if I talk anything against my mother-in –law
 Nurse; yes, it makes sense that you get upset
when your husband beats you own complaining
against your mother-in –law. I wonder if you
would like to explain further
 The nurse is validating the appropriateness of the
feelings of being upset about the patient’s
husband beating her.
REFLECTING
 In reflection the nurse highlights the affective
content of the patient ‘s communication that is
the feeling or attitude which is implicitly
expressed
For example----
 Patient; I am very angry with my wife

 Nurses; it sound that you are really angry with

your wife
 The nurse use of reflection helps the patient to
make further or additional clarification about
the statement
 Providing personal, social and therapeutic
information increases the patient resources
for example ,the nurse inform the patient
that a social worker will be here from 10a.m –
1 p.m today . group therapy will be from 2 p.m.to
3p.m.tomorrow .the patient make ask for more
information and utilize the opportunity to clarify
doubts
CLARIFYING
The nurse’s formulation of a patient ‘s
statement or expression of feelings in clearer
terms without indicating approval or disapproval
For example----
 Patient; I am very sad today

 Nurse; you say you are feeling very sad today

.would you elaborate what is happening?
Explanation given by the patient will clarify
further what is making him feel sad
PARAPHRASING
In paraphrasing the nurse restates whatever
she has heard from the patient
For example----
 Patient; sister, all my friends and relatives point
out tat I will never be able to look after my family
members. that makes me depressed
 Nurse; I hear you saying that whenever you meet
any one, your friends and relatives they point out
that you will always remain sick and will be no
good to your family. This makes you more sad
 the nurse’s paraphrasing gives a feeling to the
patient to test whether she has understood what
he want to communicate
PINPOINTING
 The nurses pays attention to certain
consistent statements, made by the patient . She
pinpoints the difference in what the patient
says and what he does
 Nurse; so you and your father don’t agree to
the girl you want to be marrying. The nurse
may point out “you say you are sad ,but you
are smiling “
LINKING
 The nurses try to link the patient’s two events,
feelings or persons together
 Nurse; you fight with your wife because her
friends visit her too frequently and you feel
neglected
QUESTIONING
Question in communication is used when the
nurse want clear information. too many question
should be avoided . the nurse can use open –
ended or close –ended questions . close ended
questionnaire with the answer of ‘yes’, or
‘no’,’right’or ‘wrong’. Open ended question gives
more chance for the patient to speak
FOCUSING
 Concentrating on one single point

 Nurse: since when did you start taking

alcohol?
 Patient: 20 years

 Nurse: how did you start taking it?

SHARING
The nurse think about the patient other than
time she looks after him. She may evaluate
whether their interactions are helping the patient.
She may say:”I was thinking of you yesterday “.
This is definitely a gesture of warmth and
thinking caring according to Indian culture. The
patient may also feel that the nurse is caring for
him
SUMMARIZING
In summarizing the nurse highlights the
main them of what has been discussed
.summarizing is useful in focusing the patient’s
attention on what he has discussed if he would
like to add or delete anything.
 Genuineness
 Openness
 Honesty
 Sincerity
 Active involvement
 Accepting the client as he is
 Personal freedom to the client
 Respect

 Warmth
 Positive regard
 Self respect
 Respecting others
 Caring
 Concern
 Liking
 Valuing
 Worth fullness
 Non-judgemental
 Maintain confidentiality
 Active listening
 Confrontation
 Immediacy
 Nurse self disclosure
 Patient self disclosure
 Emotional catharsis
 Role play
 Skill is the ability or efficiency of
the nurse to utilize their knowledge
systematically and effectively in
proficiency manner
 Ability to listen
 Interpret
 Ability to read
 Ability to express on self in writing
 Ability to speak
 Ability to observe and interpret observation
 Ability to guide the nurse patient interaction in
ordered to accomplish goals
 Ability to ascertain if communication is taking place
between the nurse and the patient
 Ability to recognize when to speak and when to be
silent –developing a sense of timing
 ability to wait – to proceed at the patient’s
pace/speed
 Ability to evaluate participation of the patient in the
nurse patient relationship
 THERAPEUTIC NURSE PATIENT
RELATIONSHIP

Repeated human contacts are

essential to develop trust, love,
tenderness, concern and acceptable
nature
A meaningful ongoing communication with the
client in an atmosphere of mutual respect and trust
where by close helping relationship will be
established which allows the nurse and the client to
work collaboratively

-Wanda, K Mohr,2006
 Genuineness
 Sincerity
 Respecting the client
 Shows love and affection
 Concern
 Active listener
 Empathy
 Self –discipline
 Role modal
 Good communication skill
 Immediacy
 Exploration of the problem
 It is a therapeutic goal directed relationship
between the nurse and the client
 To bring insight and behavioural change
 To develop mutual growth between two
individuals
 To promote realization ,self acceptance, and an
increased genuine self respect ,self identity and
personal integration
 To identify appropriate nursing approaches
 To achieve developmental goals
 Nurse assists the client to identify present
problems realistically and try out new patterns
of behaviour
 Helps the client to communicate freely
 Accountability for health can be achieved
 To provide safe and therapeutic environment.
Hopefulness and support facilitates the optimal
growth for the client .the dimensions includes
 Self realization
 Self acceptance
 Genuineness
 Self respect
 A clear sense of personal identity
 Improved level of personal integration
 Ability to form intimate ,interdependent
,interpersonal relationships with client and his
family
 Achieves realistic goals
 Improve functioning capacity
 Interaction are planned with specific time and
place
 Increased ability to satisfy and fulfil the need of
client
 Ability to give and receive love
 Time is limited
 Clarifies client’s conflicts and anxiety
 Identifies and maximize the client’s ego
strengths
 Encourages socialization and family
relatedness
 Corrects communication pattern and
encourages the client to communicate
 Modify mal adaptive behaviour into adaptive
behaviour
 Respect the cultural values of the client
 Focuses on goals, accepts the client as he is
 Allow time for the client to complete the rituals
 Treat the client as an individual
 Accept client as he is
 Aware total needs of the client
 Nurse understand herself and client’s needs
,motives , desires , feelings and fears
 Emotional involvement is essential
 Objectivity has to be maintained
 Consistency in behaviour
 Set appropriate limits and goals
 Encourage the clients feeling
 Therapeutic understanding
 Honest and open communication is needed
 Engage in active listening
 Discuss on fear with qualified person
 Realistic approach
 Establish trust and rapport
 Win the confidence of client
 Sufficient time has to be provided to the client
to respond
 Individual attention is needed to meet the total
need of each client
 Pre interaction phase
 Introductory o orientation phase
 Working phase
 Termination phase
 Pre interaction means a phase which a nurse
goes through before the actual interaction with
the patient. This phase begins when the nurses is
assigned a patient to develop therapeutic
relationship with him till she goes to him for
interaction .
 The nurse collects data/information
about the client and family members, from client
charts, OPD report, assess the total needs and
demands of the client. Plan the activities to reach
the goal
 The nurse explores her fears and anxiety
 Sets the objectives for the interaction phase
 Takes the help of the client supervisor to
overcome fears
 Introductory or orientation phase begins
when the nurse goes to the patient introduce
herself and get introduction about him. The
nurse and the patient who are strangers meet for
the first time and become acquaintance .the
orientation phase ends when the nurse and the
patient begin to accept each other as a unique
human being
 Establishment of contact
 Pact
 Talking with the patient
 Working phase or phase of emerging
identities of the nurse patient relationship starts
when the nurse and the patient are able to
overcome the barrier of orientation or
introductory phase.
 During this phase the nurse and the patient
actively work on meeting the goals which they
had established during the orientation phase.
the characteristic features of this phase are that
the nurse is able to overcome anxiety and the
patient’s fear of the unknown is also decreased
 The nurse collects the data in detail from primary
and secondary sources and identifies the needs of
the patient
 The nurse assist the patient to identify his or her
problems
 She helps the patient to communicate
 She encourages the patient socialize
 The nurse helps the patient to find an alternative
solution to his or her problem
 She encourages the patient to use new pattern of
behaviour
 The nurse helps the patient to understand that he
has a significant role in his treatment
 Termination phase is also called a resolution
phase or end phase. The termination phase
begins during the orientation phase. In the
orientation or introductory phase the nurse
develops pact or contract with the patient. In
the pact the nurse explains the patient her
purpose of interacting with him or he and
termination the relationship .the main objective
of the termination phase is to bring a
therapeutic end the nurse patient relationship
 Bring therapeutic end to the relationship
 Review feeling about the relationship
 Evaluate progress towards goal
 Establish mechanism for meeting future
therapy needs
 Not listening properly
 Maintaining dominance in therapeutic interaction
will not benefit both
 Giving reassurance , false hopes will not contribute
the therapeutic relationship
 Too much probing into personal matters in the
beginning usually goes wrong
 without listening to the client’s feeling and
problem
 Too much advising the client is not good
 Utilizing denial process in therapeutic nurse
patient relation ship
 Towsend Mary C,(2007) psychiatric mental health
nursing ,fifth edition, (P.p: 118-130), jaypee
publication.
 Potter and Perry ,Text book of Fundamental of
nursing, Communication, 7th edition, (P.P340-355),
jaypee publication.
 Neeraja K.P,(2008),Essential of mental health and
psychiatric nursing, Therapeutic communication,
first edition volume one, (P.P 196-220) jaypee
publication.
 R Sreevani,a guide to mental health nursing,4th
edition,[p.p104-116]jaypee publication.
 RESEARCH ARTICLE
Review Article on
Therapeutic communication in nursing
students: A Walker & Avant concept analysis
Author
Mahbobeh Abdolrahimi et al.
Published on
Electron Physician. 2017 Aug; 9(8): 4968–4977.
Published online 2017 Aug 25.
doi: 10.19082/4968
BACKGROUND
Therapeutic communication, the
fundamental component of nursing, is a complex
concept. Furthermore, the poor encounters
between nursing student and patient demonstrate
the necessity of instruction regarding therapeutic
communication. The aim of this study was to
define and clarify this important concept for
including this subject in the nursing curriculum
with more emphasis.
A literature search was conducted using
keywords such as “nursing student”, “patient”
and “therapeutic communication” and Persian-
equivalent words in Persian databases (including
Magiran and Medlib) and English databases
(including PubMed, ScienceDirect, Scopus and
ProQuest) without time limitation. After
extracting concept definitions and determining
characteristic features, therapeutic
communication in nursing students was defined.
Then, sample cases, antecedents, consequences
and empirical referents of concept were
determined..
After assessing 30 articles, therapeutic
communication defining attributes were as follows:
“an important means in building interpersonal
relationships”, “a process of information
transmission”, “an important clinical competency”, “a
structure with two different sections” and “a
significant tool in patient centered care”.
Furthermore, theoretical and clinical education and
receiving educators’ feedback regarding therapeutic
communication were considered as antecedents of the
concept. Improving physical and psychological health
status of patient as well as professional development
of nursing students were identified as consequences
of the concept.
 Nursing instructors can use these results in
order to teach and evaluate therapeutic
communication in nursing students and train
qualified nurses. Also, nursing students may
apply the results to improve the quality of their
interactions with patients, perform their
various duties and meet patients’ diverse
needs.